Five-year results evaluating the healing of intrabony defects following treatment with A-PRF+ or EMD: a randomized controlled trial

The aim of the study was to clinically evaluate the long-term healing of intrabony periodontal defects treated with a new-generation platelet-rich fibrin (A-PRF+) compared with enamel matrix derivative (EMD). Thirty intrabony defects in 18 patients were randomly assigned to treatment with A-PRF+ (test, n = 15) or EMD (control, n = 15). Clinical parameters were assessed at baseline, 6 months, 1 year, and 5 years post-surgery. Clinical attachment level (CAL) was the primary outcome variable. Following full-thickness flap elevation, defect debridement, scaling, and root planning were performed. Defects were filled with A-PRF + or EMD according to group allocation and stabilized with sutures. At the 5-year follow-up, 26 defects in 14 patients were available for evaluation. Both treatment methods resulted in statistically significant PD reductions, respectively CAL gains after 6 months, and the results were maintained 5 years post-operatively. At 5 years no statistically significant differences were found between the two groups as the mean CAL gain was 2.92 ± 1.65 mm in the test group, and 3.84 ± 1.81 mm in the control group, respectively (p < 0.05). Within the limitations of this study, A-PRF+ demonstrated clinical outcomes comparable to EMD in the surgical treatment of intrabony periodontal defects, with stable long-term results. A-PRF + may represent a reliable autologous alternative for periodontal regeneration, offering favorable and stable clinical outcomes over a five-year period.